Background: In the emergent setting of percutaneous coronary intervention (PCI) in patient with acute myocardial infarction (AMI), drug-eluting stent (DES) has been significantly reduced in-stent restenosis (ISR). However, DES gives a matter of concern about increased thrombogenicity. We sought to compare the efficacy and safety between BMS and DES in patients undergoing primary PCI. Methods: From June 2003 to June 2007, total one hundred three consecutive patients with AMI who had underwent primary PCI with BMS or DES were enrolled (BMS group; 47 patients vs. DES group; 56 patients). We intended to compare the major adverse cardiac events (MACE) including cardiac death, non-fatal MI, target lesion revascularization (TLR) and cerebrovascular accident (CVA) between both groups. Results: There were no significant differences in the baseline clinical and angiographic profiles except age that DES group was older than BMS group (61 짹 13 vs. 56 짹 14, p < 0.05). At 2-year follow-up, the cumulative incidence of MACE was significantly higher in the BMS group compared with the DES group (28.6% vs. 9.8%, p < 0.05), mainly due to the higher rate of TLR (HR 3.73 [95% CI: 1.3–10.6]; p < 0.05). In addition, there is no difference in stent thrombosis between DES and BMS [DES: 2 (3.6%) vs. BMS 1 (2.1%), p = 1.00] Conclusion: In the emergent setting of PCI in patient with AMI, primary PCI with DES seems to be significantly effective and safe in long-term clinical and angiographic outcomes compared with BMS.